Winston Husbands

AIDS Optimism, Condom Fatigue, or Self-Esteem? Explaining Unsafe Sex Among Gay and Bisexual Men.

This study examines leading explanations for unsafe sex in light of in‐depth interviews with 102 high‐risk gay and bisexual men in Toronto to see how well they engage with the social circumstances and reasoning processes of men in their sexual relationships. We argue that there is an inadequate fit between some of the leading explanations and the discursive accounts provided by high risk men themselves. Their accounts focus on unsafe sex occurring as a resolution to condom and erectile difficulties, through momentary lapses and trade offs, out of personal turmoil and depression, and as a byproduct of strategies of disclosure and intuiting safety. This study examines, in particular, the circumstances and rationales associated with men who identify their practices as “barebacking.” We conclude with recommendations for communicating prevention messages to those most at risk based on the self‐understandings of gay and bisexual men who most frequently practice unprotected sex.

Experiences of and responses to HIV among African and Caribbean communities in Toronto, Canada

Abstract African and Caribbean communities in Canada and other developed countries are disproportionately affected by HIV/AIDS. This qualitative study of African and Caribbean communities in Toronto sought to understand HIV-related stigma, discrimination, denial and fear, and the effects of multiple intersecting factors that influence responses to the disease, prevention practices and access to treatment and support services. Semi-structured interviews were conducted with 30 HIV-positive men and women and focus groups were conducted with 74 men and women whose HIV status was negative or unknown. We identified a range of issues faced by African and Caribbean people that may increase the risk for HIV infection, create obstacles to testing and treatment and lead to isolation of HIV-positive people. Our findings suggest the need for greater sensitivity and knowledge on the part of healthcare providers; more culturally specific support services; community development; greater community awareness; and expanded efforts to tackle housing, poverty, racism and settlement issues.

The MaBwana Black men's study: community and belonging in the lives of African, Caribbean and other Black gay men in Toronto

In Canada, there is a paucity of research aimed at understanding Black gay men and the antecedents to risk factors for HIV. This study is an attempt to move beyond risk factor analysis and explore the role of sexual and ethnic communities in the lives of these men. The study utilized a community-based research and critical race theory approach. Semi-structured interviews were conducted with eight key informants to augment our understanding of Black gay men and to facilitate recruitment of participants. In-depth interviews were done with 24 Black gay men. Our data showed that the construction of community for Black gay men is challenged by their social and cultural environment. However, these men use their resilience to navigate gay social networks. Black gay men expressed a sense of abjuration from both gay and Black communities because of homophobia and racism. It is essential for health and social programmers to understand how Black gay men interact with Black and gay communities and the complexities of their interactions in creating outreach educational, preventive and support services.

Silence, assent and HIV risk

Based on interviews with 34 men, almost all of whom have unprotected sex with men most or all of the time, this paper documents the interactional process, narrative elements and meaning construction in situations of ‘bareback’ sex. Narratives show the differentiated cultural capital circulating among distinct circuits of gay and bisexual men that define the taken‐for‐granted rules of conduct for sexual interactions and give rise to high‐risk situations. Many of the positive men speak of being part of a social environment where ‘everybody knows’ a set of rules whereby sex without condoms can happen as a default circumstance to be interrupted only when a partner asserts a need to protect himself. The practical reasoning processes and interactional back‐and‐forth in the unfolding of sexual interactions, both on the internet and in person, show the uneven and fallible accomplishment of sero‐sorting and the generation of situations of high HIV risk and vulnerability when men from different micro‐cultures encounter each other.

Risk construction in the reinfection discourses of HIV-positive men

Interviews with HIV-positive gay and bisexual men in Toronto show a widespread attentiveness to the question of HIV reinfection or super-infection as a concern in safer sex decision-making. Examination of HIV reinfection discourses shows how sero-positive men find themselves at the nexus of expert knowledge and responsibilizing trends in relying on, interpreting, and extending medical evidence in constructing risk for self and others. While not an issue that overrides all others, reinfection concerns play a salient role among the reasons mentioned by those practising safe sex, and are often weighed against competing incentives and discourses by those who do not.

Black gay men as sexual subjects: race, racialisation and the social relations of sex among Black gay men in Toronto

In this study of Black gay and bisexual men in Toronto, sexually active survey participants reported on their sexual behaviours with male partners of different ethnoracial backgrounds, and interview participants reflected on how their sexual relationships emerged in the context of race and interracial desire. Most survey participants reported sexual relationships with other Black men. Participants were more likely to be insertive with White and other ethnoracial men than with Black men. A significant number of participants who were receptive or versatile with Black partners switched to the insertive role when their sexual partners were not Black. Interview participants ascribed a sense of fulfilment to their sexual relationships with other Black men, but avoided relationships with White men or interpreted such relationships as either purely sexual and/or inflected by their racialised objectification. Others avoided sexual relationships with other Black men or preferred relationships with White men, sometimes in opposition to experiences of oppressive masculinity from some Black partners but mindful of the possibility of racialised encounters with their White partners. Study participants emerge as informed sexual subjects, self-conscious about their sexual relationships and variously inclined to negotiate or resist racialisation and oppression in the private and public spheres.

Counselling, Case Management and Health Promotion for People Living with HIV/AIDS: An Overview of Systematic Reviews

Our objective was to identify all existing systematic reviews related to counselling, case management and health promotion for people living with HIV/AIDS. For the reviews identified, we assessed the quality and local applicability to support evidence-informed policy and practice. We searched 12 electronic databases and two reviewers independently assessed the 5,398 references retrieved from our searches and included 18 systematic reviews. Each review was categorized according to the topic(s) addressed, quality appraised and summarized by extracting key messages, the year searches were last completed and the countries in which included studies were conducted. Twelve reviews address topics related to counselling and case management (mean quality score of 6.5/11). Eight reviews (mean quality score of 6/11) address topics related to health promotion (two address both domains). The findings from this overview of systematic reviews provide a useful resource for supporting the development and delivery of evidence-informed support services in community settings.ResumenNuestro objetivo fue identificar todas las revisiones sistemáticas relacionadas al asesoramiento, el manejo de casos y la promoción de la salud en personas que viven con el VIH/SIDA. En las revisiones identificadas, evaluamos la calidad y aplicabilidad local para respaldar políticas y practicas informadas por la evidencia. Realizamos búsquedas en 12 bases de datos electrónicas, dos evaluadores revisaron de forma independiente las 5398 referencias identificadas e incluimos 18 revisiones sistemáticas. Cada una de las revisiones incluidas fue clasificada de acuerdo al tema presentado, valorada en terminos de su calidad, y resumida en base a la extracción de los mensajes principales, el ultimo año en que la busqueda tuvo lugar y los países incluidos en los estudios que formaron parte de la revisión. Doce revisiones abordan temas relacionados con el asesoramiento y el manejo de los casos (con un promedio de puntuación de calidad de 6.5/11). Ocho revisiones (con un promedio de puntuación de calidad de 6/11) abordan temas relacionados con la promoción de la salud (dos revisiones abordan ambos dominios). Los resultados de este compendio de revisiones sistemáticas constituyen un recurso útil para respaldar el desarrollo y la prestación de servicios de apoyo debidamente informados por la evidencia en contextos comunitarios.

Is any job better than no job? Labor market experiences and depressive symptoms in people living with HIV

The purpose of this study is to determine the relationship between the psychosocial work environment and labor market experiences (including unemployment) on mental health among adults living with HIV. We used data provided by 538 participants at clinical and community sites across Ontario, Canada. Generalized estimating equation models showed that employment was associated with lower depressive symptoms. For employed participants, adverse psychosocial work conditions, specifically job insecurity, psychological demands, and decision authority were associated with depressive symptoms. For the entire sample, the number of adverse psychosocial work conditions was associated with higher depressive symptoms while participants working in poor quality jobs reported similar levels of depressive symptoms than those who were unemployed or not in the labor force. This study showed that poor quality employment (as assessed by having a high number of adverse psychosocial work exposures) was associated with a similar level of depressive symptoms as unemployment, suggesting that “bad jobs” may not offer the same mental health benefits as “good jobs.” Policies to improve employment outcomes should take the quality of employment into account to maximize mental health benefits as better employment may lead to better mental health.

HIV Testing by Black MSM in Toronto: Identifying Targets to Improve Testing

Surveillance data suggest that Black men who have sex with men (MSM) in Canada contribute to a higher than expected percentage of new HIV diagnoses. HIV testing is an important part of the HIV reduction strategy in Canada and the Public Health Agency of Canada recommends HIV testing as a component of periodic routine medical care. A cross-sectional survey was conducted among Black MSM in Toronto to determine the factors associated with HIV testing. One hundred sixty-five men were recruited and completed a self-administrative questionnaire. The majority of men identified as gay/homosexual. Lifetime history of HIV testing was reported at 85%, of whom 50% had tested within the last 6 months. Self-reported HIV seroprevalence was 24%. In logistic regression, variables associated with ever testing for HIV were “having friends or family with HIV” and “regularly attending religious services.” Although HIV testing appears to be common among Black MSM in Canada, young Canadian-born men were less likely to test. This observation highlights the need to examine place of birth when tailoring health interventions for Black MSM.

Sexual health determinants in black men-who-have-sex-with-men living in Toronto, Canada

Purpose – The purpose of this paper is to develop a profile of the sexual behavioural characteristics of black men who have sex with men (MSM) in the Greater Toronto Area (GTA), Canada who constitute a unique mixture in terms of background, race, ethnicity, and culture. Having a profile of the sexual health and risk taking behaviours of these men is important since it provides information on these black Canadian men in comparison other black MSM. Design/methodology/approach – Data were collected as part of a cross-sectional study of black MSM in GTA. Survey participants completed a questionnaire requesting information on socio-demographic characteristics, sexual behaviour, general and mental health, and awareness of social marketing strategies for gay men. The study was conducted in 2007-2008, through convenience sampling. Based on the data collected, the authors characterized the profile of black MSM with respect to sexual risk behaviours. Findings – The authors collected data on 168 black MSM. These men...